We're all about children!
 August 2005
This edition:
Letter from the Chair
It is a pleasure to recognize the Division of Allergy and Pulmonary. Michael Bowman, MD, has been a force in creating a clinical and research division at MUSC Children's Hospital. Dr. Bowman recruited Dr. Fred Schaffer using a model of an MUSC/private office practice that was innovative and exciting. Dr. Susan Brooks worked with us part-time for a year as a pulmonologist. Dr. Isabel Virella-Lowell joined the division with clinical expertise in pulmonary, especially cystic fibrosis and with a strong funded research program. Recently, Dr. Michelle Montalbano has joined us for 10 months as an allergist/pulmonologist and will be with the division for the next 10 months until she joins her husband who will be relocating secondary to his military service. Dr. Bowman is a man who enjoys seeing patients, managing their problems, day or night, and loves to impart his knowledge. Dr. Virella-Lowell comes from a strong lineage of clinician researchers and teachers, her father and mother are both on staff at MUSC. Dr. Virella-Lowell's expertise has allowed her to establish her own laboratory efforts, dove-tailing in with those of the pulmonary research group headed by Dr. John Baatz (an internationally recognized researcher in surfactant. I am extremely proud of the many accomplishments of this group. Dr. Bowman is a leader at MUSC. His division is being built with a superb underpinning of strong clinical care, teaching and research. It is the paradigm for the "Triple Threat Division." I am sure that you will read with delight about the development of our pulmonary division. We are very proud to have this marvelous group. Sincerely,  L. Lyndon Key, MD Chair, Department of Pediatrics Feature Story: Division of Pediatric Pulmonary, Allergy and Asthma
The Division of Pediatric Pulmonology, Allergy and Asthma at MUSC is led by Michael Bowman, PhD, MD. Recruited in 2000 from a children's hospital in California, Dr. Bowman came to MUSC Children's Hospital to establish the division, conduct research and aid in the training of pediatric residents and medical students. "When I arrived at MUSC, children with lung diseases saw community allergists or adult pulmonologists or even went out of town for care," says Dr. Bowman. "I came here with the goal of establishing a premier academic pediatric pulmonology program, hoping for the addition of allergy and immunology at some point." The pulmonology division is now responsible for the care of some 2,000 patients suffering from a variety of lung diseases and allergies - asthma, apnea, bronchiolitis, bronchopulmonary dysplasia (BPD), cough, cystic fibrosis, respiratory failure and tuberculosis, to name a few. They provide outpatient and inpatient care and offer consultation services to other divisions within the hospital. Working with Dr. Bowman are two full-time physicians, two-part time physicians, a nurse practitioner and a division secretary. The pulmonologists work closely with their adult counterparts to care for children with cystic fibrosis in a unique program called Project Independence. "With the increased survival rate of cystic fibrosis, children with the disease are living well into adulthood," says Dr. Bowman. "With Project Independence, we start encouraging our patients at age 14 to be responsible for their own care. Parents have had years to learn how to care for their child; the child needs to learn how to care for him or herself and understand the consequences of their actions or inactions when it comes to managing their disease." As part of caring for cystic fibrosis patients, an adult practitioner participates in diagnosing the case and talks with the parents about the illness. The adult practitioner sees the child again at the start of high school and during the latter part of their senior year. "By the time the child is ready for college, he or she has established a significant relationship with the adult practitioner and should be ready to transition to that physician," says Dr. Bowman. Important research activities around the world have led to the increased survival rate for cystic fibrosis patients. Dr. Bowman and his colleagues are busy themselves with CF-related research activities. "My colleague, Dr. Isabel Virella-Lowell, devotes 75 percent of her time to research, primarily CF and airway inflammation," say Dr. Bowman. "She has a new project studying vitamin D metabolism in patients with CF, and I'm involved in developing new antibiotics and other treatments for the disease." Additionally, the division is very active in the teaching program for both residents and medical students. "All of our faculty members teach residents who are caring for our patients on the inpatient service and those students who choose to take our electives in pediatric pulmonology or in allergy/immunology," says Dr. Bowman. "We give lectures to residents about once a month and have just started a month-long pulmonary elective for fourth year students." With specialized care for children suffering from respiratory diseases, allergies and asthma now available at MUSC, the patient population has grown. "When I first came, we had 43 pediatric and 45 adult patients with cystic fibrosis and no clinic or in-house pulmonary patients except for those with CF," says Dr. Bowman. "Now we have about 75 of each age group of CF, and we have a state program to identify children with CF by newborn screening. Our inpatient and outpatient services have grown in numbers and complexity. Our clinical and basic science research programs are blossoming. And we've done a lot of teaching in the community as well as here at MUSC Children's Hospital. In the near future, we want to add more faculty and staff so we can help more children in need of our specialty." Establishing a division from the ground up is no easy task, but Dr. Bowman's efforts, and those of his staff, seem to be working. Message from the Medical Staff
MUSC Children's Hospital has developed a pediatric respiratory care department to complement the excellent clinical leadership of our division of pediatric pulmonary, allergy and asthma. The respiratory care department is comprised of 35 respiratory therapists who have special expertise and experience in caring for the respiratory care of children. The seasoned personnel in this department average 15.5 years experience in respiratory therapy with an average of more than eight years at MUSC Children's Hospital. They provide outpatient and inpatient care with serial respiratory monitoring, aerosol treatments, chest physiotherapy and ventilator management. The respiratory therapists have also participated in important clinical and bench trials of new therapies such as surfactant, nitric oxide and heliox that have revolutionized the respiratory care of some of our sickest patients. For many years, MUSC Children's Hospital has invested in state of the art respiratory care equipment including high frequency oscillators, the most modern ventilators and monitoring devices. Our children's hospital through the combined efforts of the division of pediatric pulmonary, allergy and asthma, the pediatric respiratory care department and investigators in the Charles P. Darby Children's Research Institute will continue our extensive focus on the innovative treatments of respiratory diseases in children. Update from the Administrator
Several years ago, I attended a conference in Seattle where I was lucky enough to hear a presentation by Pat Votava and her colleagues on the Medically Fragile Children's Program in Columbia, South Carolina. I was impressed with the commitment between the hospital and state agencies to provide an efficient operation with excellent outcomes for children. We are now very excited to have Pat join the MUSC team to manage our new program. Like Columbia's program we have had great cooperation with the Department of Social Services and Health and Human Services in replicating the program here in Charleston. We expect to see similar outcomes in chronically ill children -- fewer emergency department visits and inpatient admissions and focused care to help these children reach their fullest potential. The staff, including medical director, Kara Blevens, MD, is very excited about the start of this unique service. The Medically Fragile Children's Program will be an example for other facilities and states on how comprehensive care can be successfully provided to a complex medical population with excellent outcomes. MUSC Children's Hospital continues to strive to provide excellent care for children. After all, we are all about kids! Children's Research Institute News Brief
The research goals of the pediatric pulmonary biology program focus on the molecular and cellular events required for normal perinatal pulmonary adaptation, as well as finding treatment or cure of pediatric lung diseases. This program is built around the strengths and ongoing interactions of MUSC faculty representing clinicians and basic scientists in pediatric pulmonology and several other departments on campus. This foundation will foster growth in pediatric pulmonary biology research, and will also promote further cooperative efforts with other investigators in the Charles P. Darby Children's Research Institute. The program includes a group of established senior and junior investigators currently at MUSC that form a strong alliance that will address underlying mechanisms and treatments of pediatric pulmonary diseases. This program will also place emphasis on development of research projects that address lung diseases indigenous to South Carolina and to southeastern coastal regions. The strengths of the investigators in this program will fuel interactive and translational research projects pertaining to pediatric pulmonary biology at MUSC and with other medical institutions. Four areas of focus are:
One specific project will focus on determining the structural/function relationships of pulmonary surfactant proteins. The long term goals of this research include delineation of the underlying mechanisms for normal surfactant protein function and development of surfactant based therapies for treatment of respiratory distress syndrome, genetic surfactant protein deficiencies and both viral and bacterial lung infections. An increasing amount of evidence indicates that exposure of pregnant mothers to second hand and/or direct cigarette smoke may impact neonatal lung development and surfactant protein secretion or function. We are in the preliminary stages of designing experiments and protocols to obtain preliminary data for a grant proposal submission that would address these issues. The objectives of this project would be: 1) to determine the effects of second hand smoke byproducts on surfactant protein function, 2) to assess the effects of cigarette smoke exposure of mothers on surfactant protein secretion in neonates using a mouse model, 3) to define the effects of second hand smoke exposure on key components of the innate immune system of the adolescent mouse lung, 4) to determine effects of second hand smoke on oxidative state of surfactant proteins adolescent mice, and 5) to establish the pattern of surfactant protein secretion in (human) neonates of mothers exposed to direct or second hand cigarette smoke. Another project area focus is on gene therapy for correction of the CF defect, antibacterial proteins of the lung and underlying mechanisms of bacterial infection of the lung in CF. Cystic Fibrosis (CF) is the most common autosomal recessive disease in North America, with an incidence rate of ~1/3000 Caucasian live births in the US and 1/20 heterozygous carries for the genetic defect. CF results from mutations in a chloride channel, the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) and re-institution of the correct gene into CF cells has been shown to correct the anion transport defect. Current therapeutic approaches to CF are symptomatic in application, as well as timely and invasive. Primary aberrations within the airways of CF patients include deficiency of cAMP-activated chloride conductance, sodium hyperabsorption, and a marked propensity for infection with Pseudomonas aeruginosa resulting in purulent inflammation and an imbalance of protease activity over antiprotease activity. Inflammation may actually precede infection. These effects ultimately result in partial or complete obstruction of the airway lumen, cytotoxicity, and destruction of the extracellular matrix. The exact mechanisms underlying the propensity to inflammatory airways disease are unknown, but may relate to an alteration in the glycosylation pattern of surface glycoproteins, increased binding of Pseudomonas aeruginosa, and an exaggerated pro-inflammatory cytokine response that might relate to the presence of a cell stress response. While some CFTR gene therapy may eventually serve to prevent the development of CF lung disease in infants, it will not have an effect in ameliorating the lung disease already present in older patients. Investigators in the Program are focusing on developing and evaluating potential gene therapies that would be more useful in patients with established lung disease, as well as examining other strategies aimed at enhancing gene transfer to the airway. In an effort to enhance gene expression in the lung, recombinant AAV (rAAV) vectors expressing alpha 1-antitrypsin or IL-10 will be constructed utilizing different promoters and/or capsid serotypes. These studies will enable researchers to determine the optimal vector dose for vector studies, that which gives the highest levels of expression with the lowest number of adverse effects. A more recent project area involves marine biomedicine in relation to lung health. Marine mammals of this area, such as bottlenose dolphins, may be more vulnerable to contaminants and biotoxins due to constant exposure and bioaccumulation of these compounds through aspiration of contaminated seawater or inhaled toxic particulates. While dolphins share similar respiratory structure with humans, dolphins have increased air exchange during respiration and increased flow rate in comparison. Therefore, increased exposures of dolphin lungs to pathogens implicate the dolphin as a sentinel for human lung health in threatened coastal environments. In an effort to assess dolphin health, immunity, and response to stress and environmental insult we aim to identify variations in expression of immunoglobin proteins and cytokines in the dolphin lung in site-specific environments so that humoral and cellular immune responses to marine bio-contaminants can be defined. Identification of antibacterial proteins in dolphin airway surface fluid may lead to unique treatments of bacterial infections in the human lung. Since children are often intrigued by the dolphin, it is a goal that this research is shared directly with the pediatric patients in the hospital setting. Mental Health Resource News Brief Back to School - Tips to Help Children Adjust Back to school time is exciting but often means changes for children and families. Smooth transitions between home and school are important to help children adapt to new situations. Transitions can be good opportunities for children to learn, but can cause anxiety. Tips for parents:
A special thanks to the following individuals for their efforts in putting together Kids Connection each month. Managing Editors: Bernard L. Maria, MD, MBA and Jessica Munday (Trio Solutions Inc.) Publisher: Jennifer Cherock (Trio Solutions Inc.) Web design: Brian Dadin (Trio Solutions Inc.) Contributing Writers: Lyndon Key, MD; Bernard Maria, MD; Inderjit Singh, PhD; Fred Tecklenburg, MD; Michelle Macias, MD; Eve Spratt, MD and John Baatz, PhD |
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